Drug-related deaths among young people in a Scottish region: a socio-ecological autopsy approach to understanding the context of drug deaths

Aims
Social, structural and systemic factors are critical to understanding drug-related deaths among adults. The relevance of these factors to young people is not known. This study explores the life experience, drug using histories and the interactions of a group of young people with agencies and services prior to their death. Our approach seeks to look beyond the immediate cause of death and identify broader contextual factors that may have contributed to a death through a “whole-life view”.

Methods
The study developed a socio-ecological autopsy approach informed by social autopsy methods and social ecology and risk environment frameworks. Health, social work, police and post-mortem records of the young people were collated and analysed. Summary narratives, chronologies and descriptive statistics were produced using Excel and NVivo.

Findings
Twenty-one deaths were identified; almost all were due to multi-drug toxicity, mainly heroin mixed with other substances. Almost all the young people had reported mental health issues such as anxiety, depression and self-harm, and had experinced at least one recorded overdose before they died. Most grew up in precarity and poverty in deprived areas. In their short lives, most of this cohort of young people experienced multiple adversities in childhood and as young adults, particularly in the year preceding their death.

Conclusions
Complex and fragmented services struggled to respond holistically to early signs of difficulties and to the young people's cumulative experience of trauma and adversity, mental ill-health and drug-related harms in the context of prohibition. There is a need for a radical rethink of systems to enable integrated youth-centred approaches that meet the needs of those at risk of drug-related deaths and to address the broader social and structural contexts of drug deaths.